The medical subplots of 2016’s Oscar-nominated films

I’ll just come out and say it: I love movies. OK, perhaps not the most scandalous statement of 2016. Yet after a long, stressful week of caring for sick patients, watching the big screen, spellbound by the expressive dialog and thrilling action sequences, my mind subconsciously gravitates to one thing: the medical aspects of the film. Even when one would least expect it, as in the finance and mortgage juggernaut, The Big Short, a health-related issue arises. This year’s Oscar-nominated films have no shortage of fascinating medical and psychiatric subplots.

The Revenant

The film that leads in nominations undoubtedly contained some of the most graphic scenes of physical human torture. After the bear’s claws ripped through Leo DiCaprio’s back, I thought, “Dear God, those deep tissue wounds are going to take a long time to heal.” Large, deep-seated, open wounds without antiseptic are also prone to infection, and ultimately septic shock. But the sensation of pain was the most visceral. As Captain Andrew stitched the major, flesh-exposing lacerations without medications, DiCaprio’s character experienced unspeakable pain. I am grateful — for my patients’ sake and my own — to live in an era with morphine and anesthesia. Perhaps the oldest and most primitive health concerns derived from Mother Nature herself.

Living in Boston, I am no stranger to long, severe winters. But out in the wilderness, far removed from fiberglass insulation and electric heaters, brave frontiersman battled snow, ice, and frigid temperatures. In addition to tissue injuries such as frostbite, hypothermia is a medical emergency: Shivering is an early symptom, but it can rapidly progress to confusion, loss of consciousness and death. Insulation is key, and those fur pelts to which Fitzgerald desperately clung, were indispensable for existence. Use of a horse’s hollowed-out carcass for warmth and shelter is an image I will not soon forget, and is a stark reminder of the human spirit’s instinct for survival.

Spotlight

Of course, not all health issues are marked by physical scars. The innocent children sexually abused by Roman Catholic priests did not present with rashes, fractured bones or bleeding gashes across their backs. Their scars were hidden — as psychological trauma often is — but just as deep and real as a physical injury, and the effects are long-term. In addition to shame and guilt, child abuse survivors can experience depression, anxiety, eating disorders and post-traumatic stress disorder. They are also more likely to engage in high-risk health behaviors: Recall the scene with survivor Patrick, now a grown man and father, who has track marks on his arms. Smoking, alcohol, drug use and unprotected sex are examples of long-term health consequences of childhood sexual abuse. Spotlight was a riveting portrayal of chronic, complex trauma.

The Big Short

In a film primarily about subprime loans and collateralized debt obligations, medical matters were minor and unaddressed. Christian Bale’s character, a former physician, has a fake eye caused by an unknown childhood illness. But I was more interested in the unexplored issues of the impact of the economic collapse on the stakeholders — not just financial, but medical, emotional and psychological. We get a brief glimpse of the devastating effect of the financial crash through the death of Steve Carell’s character’s brother. The latter dies of suicide after being “screwed over” by big banks. Unlike Spotlight, The Big Short does not delve into the long-term consequences of people losing their homes, but they’re not hard to imagine: rage, stress, depression, a sense of loss and worthlessness. These psychosocial consequences are not benign, as they can increase rates of heart attacks and strokes, as well as a plethora of other health problems.

Carol

Try as you might, you may not have noticed any medical issues in this captivating love story. And you’d be right. I bring up Carol because of its medical response to an issue which by today’s standard is not a disease: a same-sex relationship between two consenting adults. To avoid losing her daughter, Cate Blanchett’s character is forced to undergo psychotherapy to “cure” her “amoral” behavior. In the 1950s, homosexuality was considered aberrant conduct, warranting psychiatric treatment and in most cases, was punishable by law (it is still considered a crime in some parts of the world). Alan Turing, as portrayed in The Imitation Game, was sentenced for “indecency”; a judge gave the mathematical genius the option of jail or weekly estrogen injections to cure his “homosexual predilections.”

Films, ultimately, are for entertainment. And the aforementioned films, as well as many others, provided me with pure, unadulterated joy. Admittedly, as a doctor who is passionate about the health of her patients, I find the medical elements of movies endlessly fascinating, as they are a reflection of society, politics and the enduring complexity and fortitude of the human spirit.